title: Mandibular subluxation as an adjunct in very distal carotid arterial reconstruction: incidence of peripheral and cerebral neurologic sequelae in a single-center experience.
abstract: BACKGROUND
  The location of the carotid bifurcation and a very distal extension of internal carotid atherosclerotic disease may challenge vascular surgeons performing carotid endarterectomy (CEA) by increasing technical difficulty and possibly the incidence of cranial nerve damage or palsies. The objective of the present study is to report on the safety of CEA with mandibular subluxation (MS) and to compare results of CEA in 2 groups of patients treated by standard CEA or by MS-CEA according to rates of major neurologic complications, death, and the occurrence of postoperative peripheral nerve palsy.
  
  
  METHODS
  Between July 2000 and June 2012, 1,357 CEAs were performed. MS was additionally used in 43 patients. Only patients with primary atherosclerotic internal carotid artery (ICA) lesions in the 2 groups (38 in the MS-CEA group and 1,289 in the standard CEA group) were considered for comparative analysis.
  
  
  RESULTS
  MS-CEA patients were more frequently male (P = 0.03), presented more frequently with symptomatic lesions (P = 0.007), longer lesions (P = 0.01), and had common ICA bypass implantation (P = 0.02). Mean follow-up was 68.75 ± 37.87 months (range: 1-144 months). No perioperative neurologic mortality and no prolonged discomfort related to MS was recorded. The overall neurologic morbidity rate (major stroke/minor stroke/transient ischemic attach) was comparable in the 2 groups (P = 0.78). The overall immediate peripheral nerve injury rate was 7.89% in the MS-CEA group and 5.27% in the standard CEA group (P = 0.73). Three cases of permanent dysphonia in the standard CEA group (0.23%) and 1 case of dysphagia in the MS-CEA group (2.63%) were reported at follow-up (P = 0.24).
  
  
  CONCLUSIONS
  MS-CEA can be a very useful technical adjunct for high-located carotid bifurcations or challenging carotid lesions, with an overall risk comparable to that of standard CEA.
authors.affiliation: Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy. Electronic address: laura.capoccia@uniroma1.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Capoccia
authors.affiliation: Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Nunzio
authors.initials: N
authors.lastname: Montelione
authors.affiliation: Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Menna
authors.affiliation: Maxillofacial Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassoni
authors.affiliation: Maxillofacial Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Valentini
authors.affiliation: Maxillofacial Surgery Department, Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iannetti
authors.affiliation: Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Sbarigia
authors.affiliation: Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Speziale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000000981:diagnostic imaging; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome